Clinical Characteristics Of Patients Research Articles

Structural and clinical characteristics of patients with primary open-angle glaucoma based on primary care data

Structural and clinical characteristics of patients with primary open-angle glaucoma based on primary care data

Generalized paroxysmal fast activity in a cohort of patients with epilepsy with eyelid myoclonia

ObjectiveThis study aimed to analyze and summarize the characteristics of generalized paroxysmal fast activity (GPFA) via electroencephalography (EEG) in patients with epilepsy with eyelid myoclonia (EEM) and to determine its relationship with clinical outcome. MethodsPatients with EEM were selected from our EEG database. The collected data included detailed clinical information, factors that triggered GPFA, and the relationship between GPFA and eyelid myoclonia seizures. The clinical data and EEG characteristics of patients with and without GPFA were compared. ResultsForty-seven patients with EEM were identified according to the clinical criteria, of whom 18 (38.3%) exhibited GPFA. GPFA can occur ictally or interictally. The difference in the response to antiseizure medication (ASM) between EEM patients with and without GPFA suggested that patients who had GPFA on EEG might have easier seizure control. ConclusionIn our study, 38.3% of EEM patients had GPFA on EEG. GPFA is an EEG pattern in individuals with EEM that can cause eyelid myoclonia. EEM patients with GPFA on their EEG had easier seizure control than those without GPFA. SignificanceThis study summarized the incidence and electroclinical features of GPFA in a cohort of patients with EEM.

Epidemiological, clinical and microbiological characteristics of patients with biliary tract diseases with positive bile culture in a tertiary hospital

PurposeThe prevalence of biliary tract diseases, which are common gastrointestinal disorders, is steadily rising. If it progresses to sepsis or septic shock, it can endanger the patient's life. Therefore, it is crucial to promptly diagnose bacterial infection in individuals suffering from biliary diseases and comprehend the risk factors associated with infection. The objective of this study was to examine the types of bacteria present in the bile of patients with biliary tract diseases, assess any alterations in their susceptibility to antimicrobial agents, and identify the risk factors contributing to the development of infection in these patients.Patients and methodsFrom June 2019 to November 2022, 317 patients of biliary tract diseases with positive bile culture were included in this hospital-based descriptive analysis. The hospital's computerized medical records were used to collect data on demographic information (including gender, age, and occupation), laboratory, and clinical findings, physical examination results, comorbidities, basic diseases, treatment history, complications, and in-hospital outcomes. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) principles.ResultsOf the 317 patients with positive biliary tract diseases, 247 had benign diseases and 70 had malignant diseases. Patients with benign disease experienced a higher prevalence of statistically significant symptoms such as abdominal pain (81.4% vs. 57.1%, P = 0.000), nausea (31.2% vs. 14.3%, P = 0.005), vomiting (30.0% vs. 12.9%, P = 0.004), and chills (10.9% vs. 2.9%, P = 0.039), while jaundice (12.6% vs. 37.1%, P = 0.000) was more common in patients with malignant disease. At the species level, Escherichia coli (105; 40.5%), Klebsiella pneumoniae (41; 15.8%), and Pseudomonas aeruginosa (30; 11.6%) were the most commonly found Gram-negative bacterial strains in biliary tract infection. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were most susceptible to tigecycline, ertapenem and ceftazidime/avibactam, respectively.ConclusionGram-negative bacteria are the most commonly isolated biliary bacteria. Clinical doctors should pay attention to patients with malignant diseases with low hemoglobin, high total bilirubin and high alkaline phosphatase. Carbapenems, tigecycline, and minocycline are the recommended antibiotics for Enterobacteriaceae. In recent years, the proportion of enterococcus has gradually increased, and clinical attention should be paid to enterococcus infection. Linezolid and vancomycin were recommended for the treatment of Enterococci infections. Overall, this work can provide reference for clinical diagnosis, treatment and effective interventions.

Altered functional connectivity of resting-state networks and the correlation with clinical characteristics in intermittent exotropia adult patients: a resting-state magnetic resonance imaging study

BackgroundThe pathogenesis of intermittent exotropia (IXT) remains unclear. The study aims to investigate alterations of resting-state networks (RSNs) in IXT adult patients using resting-state functional magnetic resonance imaging (rs-fMRI) data to explore the potential neural mechanisms.MethodsTwenty-six IXT adult patients and 22 age-, sex-, handedness-, and education-matched healthy controls (HCs) underwent fMRI scanning and ophthalmological examinations. Brain areas with significant functional connectivity (FC) differences between the IXT and HC groups were selected as regions of interest (ROI) and mean z-scores were calculated to control for individual differences.ResultsCompared with HCs, IXT patients exhibited altered FC in various brain regions within RSNs involved in binocular fusion, stereopsis, ocular movement, emotional processes and social cognition, including the default mode network (DMN), the dorsal attention network (DAN), the visual network (VN), the sensorimotor network (SMN), the executive control network (ECN), the frontoparietal network (FPN) and the auditory network (AN). The degree of exodeviation was positively correlated with FC value of left middle occipital gyrus (MOG) within the VN. Correspondingly, we found a negative correlation between the degree of exodeviation and the FC value of left angular gyrus (AG) within FPN (P < 0.05). The FNC analysis between different RSNs also provides evidence on visual-motor cortical plasticity.ConclusionsIXT patients showed widespread changes of brain activity within RSNs related to binocular fusion, stereopsis, oculomotor control, emotional processes, and social cognition. These findings extend our current understanding of the neuropathological mechanisms of IXT.Trial registrationBeginning date of the trial: 2021-09-01. Date of registration:2021-07-18. Trial registration number: ChiCTR 2,100,048,852. Trial registration site: http://www.chictr.org.cn/index.aspx.

How effective is disopyramide in treating pediatric hypertrophic cardiomyopathy? State of the art and future directions.

Pediatric hypertrophic cardiomyopathy (HCM) has a wide range of clinical manifestations. Left ventricular outflow tract obstruction (LVOTO) at rest is present in up to one-third of children with HCM, with a further 50-60% of symptomatic children developing a gradient under exertion. Treatment options are limited, and there is a relative lack of data on the pediatric population. Disopyramide is a sodium channel blocker with negative inotropic properties. This therapy effectively reduces LVOTO in adults with HCM and delays surgical interventions, but it is not licensed for use in children. We aimed to review and analyze the influence of disopyramide over the pathophysiological, clinical, electrocardiographic, and echocardiographic characteristics of patients with HCM in infancy, childhood, adolescence, and adult age. While disopyramide remains a cornerstone in the management of pediatric HCM, the advent of mavacamten and aficamten heralds a new era of potential advancements. These emerging therapies could significantly improve the quality of life and prognosis for young patients with HCM.

Multiomics and single‐cell sequencings reveal the specific biological characteristics of low Ki‐67 triple‐negative breast cancer

AbstractBackgroundTriple‐negative breast cancer (TNBC) displays high heterogeneity. The majority of TNBC cases are characterized by high Ki‐67 expression. TNBC with low Ki‐67 expression accounts for only a small fraction of cases and has been relatively less studied.MethodsThis study analyzed a large single‐center multiomics TNBC data set, combined with a single‐cell data set. The clinical, genomic, and metabolic characteristics of patients with low Ki‐67 TNBC were analyzed.ResultsThe clinical and pathological characteristics were analyzed in 2217 TNBC patients. Low Ki‐67 TNBC was associated with a higher patient age at diagnosis, a lower proportion of invasive ductal carcinoma, increased alterations in the PI3K‐AKT‐mTOR pathway, upregulated lipid metabolism pathways, and enhanced infiltration of M2 macrophages. High Ki‐67 TNBC exhibited a higher prevalence of TP53 gene mutations, elevated nucleotide metabolism, and increased infiltration of M1 macrophages.ConclusionsWe identified specific genomic and metabolic characteristics unique to low Ki‐67 TNBC, which have implications for the development of precision therapies and patient stratification strategies.

Anatomic and Visual Outcomes of Scleral Buckle in Primary Rhegmatogenous Retinal Detachment in the Era of Pars Plana Vitrectomy

Introduction: To determine the presenting clinical characteristics of patients with rhegmatogenous retinal detachment (RRD) who underwent scleral buckling and the impact on final visual outcomes and to determine the postoperative primary attachment rate, complications, and subsequent management. Methods: This retrospective observational study comprised patients with RRD who had scleral buckling surgery from January 2016 to December 2021 with a minimum follow-up of 6 months. Results: The study comprised 307 eyes of 290 patients; 97% of eyes were phakic. Primary anatomic attachment was achieved in 93% of eyes. Macula-on detachment had a significant relationship with visual gain, while age, refractive status, number of breaks, configuration of the detachment, traumatic etiology, and lens status did not. Eyes with recurrent detachment did not have a significant visual gain after subsequent pars plana vitrectomy (PPV). Conclusions: Most eyes that underwent scleral bucking were phakic. Macular status played a significant role in the visual prognosis. The primary anatomic attachment rate after scleral buckling surgery is comparable to that after PPV. Thus, scleral buckling is far from being a procedure of the past. Multiple breaks, inferior detachments, and traumatic etiology do not appear to adversely affect the visual outcomes. Multiple vitreoretinal surgeries may not result in a visual gain in cases of recurrent detachment.

SMArt Retro study: a retrospective data analysis of the Russian registry of patients with spinal muscular atrophy

Background. Existing registries of patients with spinal muscular atrophy (SMA) 5q serve as a valuable source of information on identified patients. Information on the characteristics of Russian patients with SMA 5q and the therapy administered in real clinical practice is currently limited.Aim. To describe a cohort of Russian patients with a confirmed diagnosis of SMA 5q and to evaluate patient routing data in real clinical practice settings in Russia.Materials and methods. The present study was a descriptive non-interventional retrospective cohort study in patients diagnosed with SMA 5q who were enrolled in the Russian patient registry between January 1, 2020 and March 31, 2023. Study participants who met the inclusion criteria were automatically identified in the integrated database of the SMA 5q patient registry. Data were uploaded into validated electronic charts, verified and analyzed using descriptive statistics methods. Results. As of March 31, 2023, the Russian SMA registry contained information on 1408 patients from all federal districts and obtained epidemiological, sociodemographic and clinical characteristics of patients, as well as routes to diagnosis and treatment regimens for patients. The median time from disease onset to confirmed diagnosis was 3 months in patients with SMA type 1, 9 months in patients with SMA type 2, 20 months in patients with SMA type 3 and 68 months in patients with SMA type 4. The median time from confirmed diagnosis to the start of disease-modifying therapy was 0.5 months in SMA patients identified by neonatal screening, 21 months in patients with SMA type 1, 59 months in patients with SMA type 2, 47 months in patients with SMA type 3 and 87 months in patients with SMA type 4.Conclusion. This retrospective analysis was carried out in order to identify recent approaches to the diagnosis and treatment of SMA used in real-world clinical practice in Russia. The identified parameters (duration from the disease onset to confirmed diagnosis, duration from the confirmed diagnosis to disease-modifying therapy initiation) indicate that more widespread use of newborn screening and more rapid treatment initiation are unmet needs for SMA patients in Russia.

Ultra-Massive Transfusion: Predictors of Occurrence and In-Hospital mortality From the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR)

Few data exist on patient clinical characteristics, predictors of occurrence and short- and long-term outcomes of ultra-massive transfusion (UMT), defined as receiving 20 units or more of red blood cells (RBCs) within 48h. This study analyses UMT events from the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR). The ANZ-MTR captured all patients at 29 participating sites receiving a massive transfusion (MT), defined as ≥5 units of RBCs within 4h. Of 9028 patients, 803 (8.9%) received an UMT. UMT patients were younger than other MT patients (median age 57y vs 62y; P < .001). In UMT and MT, males predominated (66.3% and 62.9%, respectively); and context was predominantly trauma (28.8% and 23%) and cardiothoracic surgery (CTS) (21.7% and 20.3%). Median RBC units received within 4h were 16 (UMT) and 6 (MT). In UMT, 4h FFP:RBC ratio (0.6 vs 0.4, P < .001), and 4h cryoprecipitate use (72.9% vs 39.9%, P < .001) were higher. Independent predictors of UMT (Odds Ratio; 95% CI) were age <60y (1.52; 1.28-1.79), baseline Hb >100g/L (1.31; 1.08-1.59), INR >1.5 (1.56; 1.24-1.96), and APTT >60s (4.49; 3.40-5.61). Predictors of in-hospital mortality in UMT included Charlson Comorbidity Index score ≥3 (11.20, 0.60 - 25.00) and bleeding context, with mortality less likely in liver transplant (0.07, 0.01-0.41) and more likely in vascular surgery (8.27, 1.54-72.85), compared with CTS. In-hospital mortality was higher in the UMT group compared with MT group (20.5% vs 44.2%, P < .001), however 5y survival following discharge was not significantly different between the groups (HR=0.87 [95%CI 0.64-1.18], P = .38). UMT patients are more commonly younger, with baseline coagulopathy, and have higher in-hospital mortality compared with MT. However, UMT is not futile: 55.8% survived to discharge, without significant difference in survival postdischarge between the groups.

Fast-Track Score to Predict the Feasibility of Early Extubation Post Liver Transplant

Background Over the past several years, the liver transplant community has embraced the concept of fast-tracking patients to facilitate earlier postoperative recovery. Aim Derive and validate a novel “fast-track” risk score that captures the demographic and clinical characteristics of DDLT patients to predict the likelihood of early extubation after surgery. Design Adult patients who underwent non-fulminant DDLT between January 2014 and July 2019 were included. The cohort was divided in 2 groups: patients extubated within 4 hours of surgery vs extubated after 4 h. Logistic regression was performed to identify the independent predictors of early extubation. The area under the curve (AUC) was calculated to measure the ability of the risk score to predict early extubation. The score was validated by applying coefficients of the regression model to the validation cohort and calculating the AUC. Results A total of 290 DDLT patients were included, of which 175 (60%) were in the “delayed extubation” group and 115 (40%) were in the “fast-track” group. Patients with a MELD &lt;29, transfused &lt;4 units of pRBCs, and transfused &lt;5 units of FFP during surgery were 2.30 times, 5.74 times, and 3.09 times more likely to be extubated early, respectively. A risk score with an integer point scale was derived and exhibited an AUC of .80. The proportion of patients who were extubated early increased from 2.78% at a score of 0 to 66.67% at a score of 4. Conclusions The proposed score provides a fast and easy method to help identify DDLT patients suitable for early extubation.

Pleuropulmonary Manifestations in Patients with Systemic Lupus Erythematosus

Objective — to assess the prevalence of non-infectious pleuropulmonary manifestations in patients with systemic lupus erythematosus (SLE), as well as the demographic, clinical and laboratory characteristics of such patients. Materials and methods. A total of 435 patients with SLE (87.5 % female; median age 37 (26—49) years) were enrolled in a cross-sectional study, including 200 with pleuropulmonary manifestations and 235 without them. Patients were evaluated for demographic details, clinical SLE manifestations, SLE Disease Activity Index 2000 (SLEDAI-2K), SLICC/ACR Damage Index (DI). Laboratory evaluations included complete blood count with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), interleukin-6 (IL-6), IL-10, complement C3 and C4 levels, specific autoantibodies. Procalcitonin and presepsin serum levels were measured to exclude infections. Results and discussion. At least one pleuropulmonary manifestation occurred in 46 % of patients, with pleurisy being the most frequent (24 %). Respiratory involvement was associated with male sex, longer disease duration, and older age at disease onset. Patients with respiratory complications had higher SLEDAI-2K and SLICC/ACR DI scores than those without pleuropulmonary involvement. Patients with pleuropulmonary manifestations more frequently exhibited lymphadenopathy, nephritis, pericarditis, other cardiac manifestations, fever, weight loss, anemia, and thrombocytopenia; conversely, cutaneous manifestations occurred less frequently in patients with pleuropulmonary involvement. Patients with respiratory involvement were found to have higher levels of ESR, CRP, hs-CRP, and IL-6. A higher frequency of positive anti-La/SSB, antiphospholipid, and anti-chromatin antibodies was observed in patients with pleuropulmonary manifestations compared to those without them.In multivariate logistic analysis, respiratory involvement was positively associated with older age (odds ratio (OR) 1.03 (95 % confidence interval (CI) 1.01—1.05), p = 0.004), higher SLEDAI-2K (OR 1.05 (95 % CI 1.01— 1.09), p = 0.030) and SLICC/ACR DI scores (OR 11.34 (95 % CI 1.03—1.74), p = 0.027), presence of lymphadenopathy (OR 2.27 (95 % CI 1.33—3.88), p = 0.003), pericarditis (OR 4.40 (95 % CI 2.29—8.46), p &lt; 0.001), other cardiac manifestations (OR 10.1 (95 % CI 5.65—17.9), p &lt; 0.001), and systemic symptoms (OR 2.14 (95 % CI 1.24—3.70), p = 0.007). Cutaneous manifestations were, on the other hand, negatively associated with the occurrence of pleuropulmonary symptoms (OR 0.27 (95 % CI 0.15—0.50), p &lt; 0.001). Conclusions. Pleuropulmonary manifestations are frequent in SLE, particularly pleuritis. Respiratory involvement is associated with male sex, older age, longer disease duration, and occurs mainly in patients with active and severe lupus, often with previous or concomitant major organ involvement other than lungs. Patients with pleuropulmonary involvement have higher levels of inflammatory markers and higher frequency of positive anti-La/SSB, antiphospholipid, and anti-chromatin antibodies.

A Subunit-Based Concept for Preoperative Design of the Cauliflower Ear.

Cauliflower ear is an ear deformity caused by a closed ear injury with varying severity. Several studies on the systematic reconstruction of cauliflower ear have been reported. Here, the authors aim to introduce a simplified subunit-based reconstruction concept for the cauliflower ear. The authors retrospectively analyzed all patients who underwent surgery to repair cauliflower ear in our department from April 2021 to April 2023. Patients' demographic information, clinical characteristics, and outcomes were recorded. All patients were followed up for 1 year. The authors assessed each subunit of the cauliflower ear in sequence in terms of the change in size and shape and decided whether tissue removal or grafting is needed. The surgical design was obtained by a combination of all subunits. The authors included a total of 5 patients with mild and moderate cauliflower ear repaired by the subunit-based method. The shape of all the involved ear subunits of our patients was almost restored. No patient needed the use of cartilage grafts and flaps. The authors summarized 5 common subunits with deformity: helix, scaphoid fossa, antihelix crura and triangular fossa, antihelix body, and concha. The pathology results reported a keloid in 1 case. All patients reported no recurrence and were satisfied with the surgery after 1 year. The authors reported a simplified subunit-based method of preoperative evaluation and design of cauliflower ear, as a new alternative option to complement the current clinical strategies. The authors also reported the first case of a keloid in cauliflower ear.

Clinical and laboratory pattern of patients with systemic lupus erythematosus seropositive for rheumatoid factor.

The aim of the study was to investigate the associations between the presence and level of rheumatoid factor (RF) in the blood serum and the clinical and laboratory characteristics of patients with systemic lupus erythematosus (SLE). This retrospective tricentric cross-sectional study analyzed a Ukrainian contingent of SLE patients. Medical records of 495 patients were evaluated. Rheumatoid factor serum concentration was tested in 206 of them (41.6%) using turbidimetry technique. Clinical manifestations, routine laboratory parameters, specific immunological tests, disease activity (SLEDAI-2K), and damage indices (SLICC/ACR DI) were evaluated. Our study revealed that RF was elevated in 27.7% of patients. The RF-positive patients experienced a longer delay in SLE diagnosis (2.0 vs. 0.5 years, p = 0.046), less frequent kidney involvement (42.1% vs. 59.4%, p = 0.045) and fever (42.1% vs. 59.2%, p = 0.046), and more frequent lymphadenopathy (59.6% vs. 42.3%, p = 0.039) compared to RF-negative patients. Patients with RF positivity had higher levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and antinuclear antibody (ANA) titer, and were more frequently positive for antibodies to Ro/SSA and La/SSB. Rheumatoid factor concentration directly correlated with CRP (r = 0.318; p < 0.01) and ESR (r = 0.228; p = 0.04) levels. However, no associations were found between RF levels and SLEDAI-2K, joint involvement frequency, SLICC/ACR DI or drug therapy content. Univariate logistic regression analysis showed that RF positivity was independently associated with lymphadenopathy, presence of anti-Ro/SSA and anti-La/SSB antibodies, and negatively associated with kidney involvement. In RF-seropositive SLE patients (approximately 28%), the diagnosis is established later compared to RF-seronegative ones; kidney involvement and fever are less common, while lymphadenopathy develops more frequently. Rheumatoid factor seropositivity is associated with higher levels of ESR, CRP, ANA, and the presence of antibodies to Ro/SSA and La/SSB. According to the results of univariate logistic regression analysis, an independent association with RF positivity was confirmed only for kidney involvement, lymphadenopathy, and antibodies to Ro/SSA and La/SSB.

Increased Risk and Unique Clinical Course of Patient Safety Indicator-3 Pressure Injuries Among COVID-19 Hospitalized Patients.

The COVID-19 pandemic introduced unique challenges to healthcare systems, particularly in relation to patient safety and adverse events during hospitalization. There is limited understanding of COVID-19's association with some patient safety indicators (PSIs). This study aimed to investigate the impact of COVID-19 infection on the rate of PSI-3 events and its implications on quality metrics. We compared PSI-3 event rates between COVID-19-infected and uninfected patients and examined the clinical characteristics of COVID-19 patients experiencing PSI-3 events. This is a retrospective study at Mayo Clinic hospitals between January 2020 and February 2022, analyzing patients meeting PSI-3 denominator eligibility criteria. PSI-3 events were identified using AHRQ WinQI software. Patients were categorized based on COVID-19 status. Patient demographics, characteristics, and PSI-3 rates were compared. A case series analysis described clinical details of COVID-19 patients with PSI-3 events. Of 126,781 encounters meeting PSI-3 criteria, 8674 (6.8%) had acute COVID-19 infection. COVID-19-infected patients were older, more likely to be male, non-white, and had private insurance. PSI-3 rates were significantly higher in COVID-19 patients (0.21% versus 0.06%, P < 0.0001), even after risk adjustment (adjusted risk ratio, 3.24, P < 0.0001). The case series of 17 COVID-19 patients with PSI-3 events showed distinctive clinical characteristics, including higher medical device-related pressure injuries, and greater predisposition for head, face, and neck region. Acute COVID-19 infection correlates with higher PSI-3 event rates. Current quality indicators may require adaptation to address the pandemic's complexities and impact on patient safety. Further research is needed to comprehensively understand the intricate relationship between COVID-19 and patient outcomes.

Real world analysis of treatment change and response in adults with attention-deficit/hyperactivity disorder (ADHD) alone and with concomitant psychiatric comorbidities: results from an electronic health record database study is the United States

BackgroundThe objectives of this study were to examine the association of psychiatric comorbidities and patient characteristics with treatment change and response as well as to assess the association between treatment change and healthcare resource utilization (HCRU) among adult patients with attention-deficit/hyperactivity disorder (ADHD) and psychiatric comorbidities.MethodsDe-identified electronic health records from the NeuroBlu Database (2002–2021) were used to select patients ≥ 18 years with ADHD who were prescribed ADHD-specific medication. The index date was set as the first prescription of ADHD medication. The outcomes were treatment change (discontinuation, switch, add-on, or drop) and HCRU (inpatient, outpatient, composite) within 12 months of follow-up. Cox proportional-hazard model was used to assess the association between clinical and demographic patient characteristics and treatment change, while generalized linear model with negative binomial distribution and log link function was used to assess the association between key risk factors linked to treatment change and HCRU rates.ResultsA total of 3,387 patients with ADHD were included (ADHD only: 1,261; ADHD + major depressive disorder (MDD): 755; ADHD + anxiety disorder: 467; ADHD + mood disorder: 164). Nearly half (44.8%) of the study cohort experienced a treatment change within the 12-month follow-up period. Treatment switch and add-on were more common in patients with ADHD and comorbid MDD and anxiety disorder (switch: 18.9%; add-on: 20.5%) compared to other cohorts (range for switch: 8.5–13.6%; range for add-on: 8.9–12.1%) Survival analysis demonstrated that the probability of treatment change within 12 months from treatment initiation in the study cohort was estimated to be 42.4%. Outpatient visit rates statistically significantly increased from baseline (mean [SD] 1.03 [1.84] visits/month) to 3 months post-index (mean [SD] 1.62 [1.91] visits/month; p < 0.001), followed by a gradual decline up to 12 months post-index. Being prescribed both a stimulant and a non-stimulant at index date was statistically significantly associated with increased risk of treatment change (adjusted hazard ratio: 1.64; 95% CI: 1.13, 2.38; p = 0.01).ConclusionsThis real-world study found that treatment change was common among patients with ADHD and psychiatric comorbidities. These findings support the need for future studies to examine the unmet medical and treatment needs of this complex patient population.

Clinical characteristics of patients with early gastric prematurity cancer and analysis of complications by endoscopic resection.

Gastric cancer, a prevalent malignancy, poses a severe threat to the health of residents in China. Timely intervention in early stages can extend patients' survival. To analyze clinical characteristics of patients with early gastric cancer and efficacy and risk of complications associated with endoscopic resection. This study included 175 patients with early gastric cancer treated at our hospital, with no restrictions on sex or age. General data, pathological information, and endoscopic biopsy results were obtained. The clinical characteristics of early gastric cancer were analyzed, and endoscopic resection was performed. Postoperative efficacy and incidence of complications were monitored. Statistical analysis was performed using SPSS 26.0 and GraphPad Prism 8.0 software. A total of 175 patients with early gastric cancer were included, with 75.43% (n = 132) males and 24.57% (n = 43) females. 38.29% (n = 67) and 35.43% (n = 62) of patients had a history of smoking and alcohol consumption, respectively. Comorbidities included diabetes (8.57%, n = 15), coronary heart disease (10.29%, n = 18), and hypertension (43.43%, n = 76), which was highly prevalent. A history of abdominal surgery and family history of digestive system cancer accounted for 21.14% and 17.14%, respectively. The most common lesion location was the antral part of the stomach (52.00%, n = 91), followed by the gastric angle, body, and fundus. The pathological types were predominantly high-grade intraepithelial neoplasia (28.00%, n = 49) and well-differentiated adenocarcinoma (26.86%, n = 47), followed by moderately differentiated adenocarcinoma, high-moderately differentiated adenocarcinoma, and moderate-lowly differentiated adenocarcinoma. 89.14% of the patients had intestinal metaplasia and 85.14% had atrophy. After endoscopic resection, re-examination revealed that 13 patients had cancer cells at the tissue margin, with a positive margin rate of 7.43%. Postoperative complications included no cases of gastrointestinal obstruction, but incisional infection (2.86%, n = 5), gastric perforation (1.14%, n = 2), and gastric bleeding (4%, n = 7) were present, with an overall incidence of 8.00%. Analysis of the clinical characteristics indicated that early gastric cancer is more prevalent in males with a history of hypertension, with lesions most commonly occurring in the antral region of the stomach. The pathological types are often high-grade intraepithelial neoplasia and well-differentiated adenocarcinoma, with over 85% of patients having comorbid intestinal metaplasia and atrophy. Despite endoscopic resection, a positive margin rate persisted, indicating a probability of residual cancer at the margins. Postoperative complications, such as gastrointestinal obstruction, incisional infection, gastric perforation, and gastric bleeding can occur and require timely symptomatic treatment.

Multiplex analysis of post-Covid cardiorenal complications in patients with type 1 and type 2 diabetes mellitus according to the mobile diagnostic and treatment center (Diamobil)

BACKGROUND: Patients with diabetes mellitus (DM) are at risk for a higher incidence and severity of COVID-19, as well as its adverse outcomes, including post-Covid syndrome.AIM: to assess the incidence of cardiorenal complications in patients with type 1 and type 2 diabetes (T1DM/T2DM) who have had COVID-19, and to analyze the structure and severity of disorders according to examination data at the Diamobil mobile medical diagnostic and treatment center.MATERIALS AND METHODS: a cohort of T1DM and T2DM patients examined in Diamobil (n=318), with a confirmed anamnesis of COVID-19 (n=236). The time interval between COVID-19 and the visit to Diamobil was 8.7/8.2 months for T1DM/T2DM. The parameters of the last visit before COVID-19 recorded in the Federal Register of Diabetes (FRD) were used as initial data.RESULTS: Clinical characteristics of patients with T1DM/T2DM: age — 49.2/64.5 years, duration of DM — 22/11 years, proportion of women — 64/73%, respectively. After analysis the data from visits before and after COVID-19 there weren’t statistically significant differences in HbA1c levels for both types of DM (before 9.0/8.3%; after 8.4/8.2%, respectively), there was the intensification of glucose lowering therapy (the proportion of patients with T2DM on 2 and 3 component therapy increased by 4.3% and 1.6%, the proportion of patients on insulin therapy by 16%). After COVID-19, there was a statistically significant decrease in glomerular filtration rate (GFR) in T1DM from 88.1 to 62 ml/min/1.73 m2; with T2DM from 74.7 to 54.1 ml/min/1.73 m2. When assessing acute diabetic complications, there was an increase in the frequency of coma in T1DM by 1.5 times, severe hypoglycemia in T1DM by 3 times, and in T2DM by 1.7 times. Analysis of the frequency of cardiorenal complications before and after COVID-19 showed a total increase of 8.5% in T1DM, by 13.2% in T2DM, of which myocardial infarction, ischemic heart disease, and CHF increased in T1DM in the range from 1.5 to 5 times, with T2DM by 1.3 times, the frequency of CKD with T1DM by 1.5 times, with T2DM by 5.6 times.CONCLUSION: There was a decline of kidney filtration function (decrease in GFR) and an increase in the frequency of cardiovascular complications in both types of diabetes in post-Covid period while patients achieved a stable HbA1c levels by intensifying therapy during the COVID-19 infection. This fact reflects combined damage to the kidney and cardiovascular system as a part of the post-Covid syndrome and determines a key set of measures for the development of preventive strategies.

Bacterial Meningitis Following Aneurysmal Subarachnoid Hemorrhage and Its Association with Cerebral Vasospasm.

Aneurysmal subarachnoid hemorrhage (aSAH) is a critical condition with high in-hospital mortality rates. Delayed cerebral ischemia (DCI), a secondary complication associated with aSAH, can also contribute to morbidity and mortality. Although draining the hematoma from the subarachnoid space has been considered effective in preventing DCI, the placement of a drainage system could increase the risk of bacterial meningitis and ventriculitis. This study aimed to examine the association between meningitis following aSAH and the occurrence of DCI, focusing on the role of cerebral vasospasm. Patients who underwent endovascular coiling or surgical clipping for aSAH from April 2001 to March 2022 were included in this study, while those who did not undergo postoperative drainage were excluded. The patient's clinical characteristics, treatment modalities, and outcomes were then analyzed, after which logistic regression was used to assess the odds ratios (OR) for DCI. A total of 810 patients with aSAH were included in this study. Meningitis following aSAH was identified as an independent factor associated with DCI (odds ratio 5.0 [95% confidence intervals (CI) 2.3-11]). Other significant factors were female sex (odds ratio 1.5 [95% CI 0.89-2.5]) and surgical clipping (odds ratio 2.1 [95% CI 1.3-3.4]). This study demonstrated a significant association between meningitis following aSAH and the development of DCI, suggesting that the inflammatory environment associated with meningitis may contribute to cerebral vasospasm. Early recognition and treatment of meningitis in patients with aSAH could reduce the risk of DCI and improve patient outcomes.

Expert opinion on the prescription practice of artificial tear formulations for the management of dry eye disease in Indian settings: A questionnaire-based survey

Clinical studies suggested that Carboxymethyl cellulose (CMC) and Hyaluronic acid (HA) were equally effective in treating DED, other studies have shown that one treatment option outperforms the other.So, this study aimed to explore expert opinions on the use of artificial tear formulations for the effective treatment of dry eye disease (DED) in Indian settings, specifically focusing on prescribing practices for different severity levels of DED. The cross-sectional, questionnaire-based study in which data was collected through a multiple-response questionnaire. The questionnaire comprised 22 questions, covering various aspects such as the clinical characteristics of DED patients and the utilization of artificial tear formulations at different stages of the disease. Among the 54 respondents, 63% of them observed a higher prevalence of DED in individuals aged 25 to 40 years. Furthermore, 77.77% of respondents identified burning or stinging in the eyes as a significant symptom of aqueous deficiency in DED patients. As a first-line treatment for mild DED, 51.85% of participants recommended 0.5% Carboxymethyl cellulose (CMC) eye drops, while 44.44% suggested using combination eye drops containing polyethylene glycol and Propylene glycol (PEG-PG) for moderate DED cases. In the case of severe DED, the majority (68.52%) of respondents preferred prescribing sodium Hyaluronate (SH) eye drops.Experts have recommended the use of CMC eye drops to provide temporary relief from itchiness and pain caused by eye dryness, wind exposure or sun exposure. They have recommended the prescription of 0.5% CMC eye drops three times daily for mild DED patients.

The potential of a nomogram risk assessment model for the diagnosis of abdominal aortic aneurysm: a multicenter retrospective study

The incidence of abdominal aortic aneurysm (AAA) is very high, but there is no risk assessment model for early identification of AAA in clinic. The aim of this study was to develop a nomogram risk assessment model for predicting AAA. The data of 280 patients diagnosed as AAA and 385 controls in The Affiliated Suzhou Hospital of Nanjing Medical University were retrospectively reviewed. The LASSO regression method was applied to filter variables, and multivariate logistic regression was used to construct a nomogram. The discriminatory ability of the model was determined by calculating the area under the curve (AUC). The calibration capability of the model is evaluated by using bootstrap (resampling = 1000) internal validation and Hosmer–Lemeshow test. The clinical utility and clinical application value were evaluated by decision curve analysis (DCA) and clinical impact curve (CIC). In addition, a retrospective review of 133 AAA patients and 262 controls from The First Affiliated Hospital of Soochow University was performed as an external validation cohort. Eight variables are selected to construct the nomogram of AAA risk assessment model. The nomogram predicted AAA with AUC values of 0.928 (95%CI, 0.907–0.950) in the training cohort, and 0.902 (95%CI, 0.865–0.940) in the external validation cohort, the risk prediction model has excellent discriminative ability. The calibration curve and Hosmer–Lemeshow test proved that the nomogram predicted outcomes were close to the ideal curve, the predicted outcomes were consistent with the real outcomes, the DCA curve and CIC curve showed that patients could benefit. This finding was also confirmed in the external validation cohort. In this study, a nomogram was constructed that incorporated eight demographic and clinical characteristics of AAA patients, which can be used as a practical approach for the personalized early screening and auxiliary diagnosis of the potential risk factors.